Carbon Dioxide Laser Versus Stapler‐Assisted Endoscopic Zenker's Diverticulotomy: A Systematic Review and Meta‐Analysis

Abstract

To evaluate outcomes following endoscopic management of Zenker’s diverticula using a carbon dioxide laser (CO2) or stapler-assisted technique, a systematic review and meta-analysis were conducted. Seven retrospective, uncontrolled case series including 391 procedures met selection criteria. No higher quality studies were identified. Outcomes favoring the stapler technique included a shorter duration of nil per os (NPO) status (2 studies), length of hospitalization (LOH, 2 studies), and fewer postoperative fevers and abnormal chest x-rays (1 study). Outcomes favoring the CO2 technique included greater improvement in postoperative dysphagia and regurgitation scores (2 studies) and a lower revision rate (1 study). Meta-analysis demonstrated increased nondental complications in the CO2 group (odds ratio 3.81; 95% confidence interval, 1.37–10.59; P = .01) but no difference in duration of NPO (P = .06), LOH (P = .07), overall complications (P = .08), dental complications (P = .57), major complications (P = .38), or revision surgery (P = .82). Implications are limited by the quality of studies identified.

Systemic inflammatory response after endoscopic surgery of Zenker’s diverticulum

“…Due to its good safety and long-term efficacy, rigid endoscopic surgery of Zenker’s diverticulum has become increasingly popular, although there is some controversy about the optimal surgical method 14-16 . A recent meta-analysis demonstrated increased non-dental complications in patients treated by CO 2 laser compared to patients treated by stapler, but no difference in overall complications or revision surgery 17 . Endoscopic surgery for Zenker’s diverticulum can be complicated by inflammatory processes and mediastinitis 18 .…”

Diverticulosis and its complications in the foregut and small bowel

“…Surgical management includes endoscopic diverticulotomy versus operative myotomy with or without diverticulectomy or diverticulopexy (5). The two main modalities in endoscopic treatment are carbon dioxide laser and staplerassisted techniques (5,6). Endoscopic management has gained popularity because it is minimally invasive and the patient population with this condition is typically…”

Foregut Diverticula

“…5) Carbon dioxide laser and stapler-assisted techniques are the two main endoscopic treatment modalities. 5,6) Endoscopic management has gained popularity, as it is minimally invasive, and the patient population with this condition is typically elderly with likely multiple medical comorbidities. 3) Both open surgery and endoscopic management are considered safe and effective.…”